Pharmacology: Anti-Infective and Musculoskeletal Drugs Flashcards
Exemplars of Anti-Infectives
- Penicillins
- Aminoglycosides
- Fluroquinolones
Pharmacodynamics of Penicillins
(Oxacillin)
- bind with protein-binding proteins which results in destruction of the cell wall
- bactericidal in nature
- interfere with cell-wall synthesis leading to cell death
- broad spectrum of antimicrobial activity
- treat gram-positive, gram-negative, and anaerobic organisms
Pharmacokinetics of Penicillins
(Oxacillin) (Anti-infective)
- absorbed variably in GI tract
- widely distributed throughout the body including lungs, liver, kidneys, muscle, bone, urine and placenta
- metabolized to a limited extent by the liver
- 60% excreted unchanged by the kidneys
Nursing Considerations for Penicillins
- higher incidence of anaphylactic reactions
- given on empty stomach (one hour before or two hours after meals)
- refrigerate oral suspension
- inject IM in large mass muscle
Aminoglycosides
(Anti-infective) (Gentamicin)
- absorbed poorly from GI tract; most often given parenterally
- distributed widely; crosses the placental barrier but not the blood brain barrier
- when administering with penicillins, the cell wall is altered allowing the aminoglycoside to penetrate the bacterial cell and increase drug effectiveness
Nursing Considerations for Aminoglycosides
- given via IM or IV routes
- peak and trough levels typically drawn
- effective against gram-negative bacilli, hospital-acquired infections, UTIs, CNS infections
- Side Effects: neuromuscular reactions, GI disturbances, ear + renal toxicity
Fluoroquinolones
(Ciprofloxacin)
- well absorbed via oral route, not highly protein bound, minimally metabolized in liver, excreted primarily in urine
- interrupts bacterial DNA replication stopping reproduction
- drugs in this category treat a variety of infections in specific organs
- many drugs in this category have negative effects on body systems
Nursing Considerations for Fluoroquinolones
- assess for suicidal tendencies or depression
- some oral forms can be take with food
- should be taken 2-4 hours before or 2-6 hours after antacids or other products containing calcium, iron, zinc, magnesium, or aluminum
Adverse Reactions with Fluoroquinolones
- dizziness
- nausea + vomiting
- diarrhea
- abdominal pain
Fluoroquinolones: Due to Adverse Reactions Instruct patient to
- drink a lot of fluids
- monitor bowel function
- avoid sun to prevent photo-toxic reactions
- monitor for CNS effects
- avoid hazardous tasks
Musculoskeletal Drugs Exemplars
- Bone Reabsorption Inhibitors
- Disease-Modifying Anti-rheumatics (DMARs)
- Skeletal Muscle Relaxants
Types of Bone Reabsorption Inhibitors
- calcitonin
- calcium supplements
- selective estrogen receptor modules (SERMS)
Bone Reabsorption Inhibitor: Calcitonin
used for treatment of postmenopausal osteoporosis, hypercalcemia r/t hyperparathyroidism, or Pagets disease (osteitis deformans)
Bone Reabsorption Inhibitor: Calcium Supplements
- absorption of calcium is facilitated by vitamin D
- risk for hypercalcemia, kidney stones
Bone Reabsorption Inhibitor: Selective Estrogen Receptor Modules (SERMS)
- activate estrogen receptors in bone to decrease bone loss and block estrogen receptors in breast tissue decreasing risk of recurrence of estrogen receptor positive breast cancer
- prevent and treat post-menopausal osteoporosis + breast cancer
Bone Reabsorption Inhibitor Exemplar
Biphosphonates (Alendronate)
Bone Reabsorption Inhibitor: Biphosphonate (Alendronate) Action
-decrease bone reabsorption by decreasing number of osteoclasts that cause bone breakdown
-used to treat + prevent osteoporosis in post-menopausal women
(assess patients for low bone density before and periodically during therapy)
Side Effects of Biphosphonates (Alendronate)
- GI distress
- vision problems
- muscle + joint pain
Nursing Considerations for Bone-reabsorption Inhibitors (Biphosphonates, Alendronate)
-assess for symptoms of Pagets disease
-do not use with hypocalcemia or renal insufficiency
-wait 30 minutes after taking in the morning before eating breakfast or drinking
>food can interfere with absorption
>calcium + dairy products decrease absorption
-monitor serum calcium in patients with osteoporosis
-encourage exercise + modify behaviors that increase risk for osteoporosis
Disease-Modifying Anti-rheumatics
(Methotrexate)
-suppressing the autoimmune response thought to be responsible for joint destruction in diseases such as arthritis
-methotrexate is administered weekly via multiple routes
>in higher doses, to treat cancer
>prescribed folic acid simultaneously to decrease risk of toxicity
Side Effects of Disease-Modifying Anti-rheumatics
- liver damage
- bone marrow suppression
- increase risk of infection
- GI ulceration + pulmonary fibrosis
Monitor patients using Disease-Modifying Anti-rheumatics for
Signs + Symptoms of:
- infection
- decreased platelet and RBC count
- GI bleeding
- jaundice due to liver dysfunction
- decreased oxygenation
- respiratory distress
Nursing Considerations for Disease-Modifying Anti-rheumatics
- patients with aspirin allergies should not receive other NSAIDs
- NSAIDs should be used cautiously in patients with a history of GI bleed
- NSAIDs used cautiously with patients with diabetes
- NSAIDs may diminish the response to diuretics and anti-hypertensive medications
- neither NSAID nor corticosteroids prevent disease progression or joint destruction
Skeletal Muscle Relaxants
(Diazepam)
-relieve musculoskeletal pain or spasms and severe musculoskeletal spasticity
>commonly administered for patients with multiple sclerosis, cerebral palsy, stroke, and spinal cord injuries
-Diazepam- used for musculoskeletal disease as well as anxiety, alcohol withdrawal, and seizures
Side Effects of Skeletal Muscle Relaxants
(diazepam)
- drowsiness
- dizziness
Skeletal Muscle Relaxants: due to side effects advise patients to
- change position slowly
- avoid hazardous activities until effects are known
- avoid alcohol or other depressants
- alternate activity + rest to avoid fatigue
Nursing Considerations for Skeletal Muscle Relaxants
- take with food or milk to prevent GI distress
- monitor pain level during administration
- long-term use –> physical and psychological dependence
- do not abruptly stop taking after long therapy–> cessation can result in severe withdrawal symptoms
